What Can Patients Do to Access Better Colon Cancer Care?

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What Can Patients Do to Access Better Colon Cancer Care? from Patient Empowerment Network on Vimeo.

What can patients do to access quality colon cancer care? Dr. Suneel Kamath shares tips on how to advocate for yourself, the importance of quality care versus convenient care, and colon cancer resources.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Cancer Institute. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Why Are Colon Cancer Cases in Young People on the Rise?

Why Are Colon Cancer Cases in Young People on the Rise?

 What Are Common Colon Cancer Health Disparities?

What Are Common Colon Cancer Health Disparities?

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

Transcript: 

Katherine:  

If patients feel like they’re not receiving good care or they feel like they’re being treated unfairly, what steps should they take to access better overall care?  

Dr. Kamath:  

That’s a touchy one. It makes me sad that that even happens, but it does. I would say just never be afraid to be an advocate for yourself. To me, it’s your life and the consequence of bad healthcare, unfortunately, is not going to be on those providers. It’s going to be on you. Unfortunately, I do hear from a lot of people they worry about burning bridges, or annoying someone, or angering the doctors that they’re working with. I would tell them, “Don’t worry about that.” I don’t think people need to care about my feelings or the doctor’s feelings about the situation. 

You need to make sure you’re getting the best healthcare possible. Always feel comfortable getting a second opinion, going to a bigger center. I always recommend go to the main hospitals in your area. In the U.S. especially, I think we’re too focused on convenient healthcare and not the quality of the healthcare. I would definitely advocate, even if it takes you an hour to drive downtown to Duke or Johns Hopkins in your area, or the Cleveland Clinic, or the Mayo Clinic, or whatever, it’s worth that time compared to the person who just might be five or 10 minutes from you.  

Katherine:  

Right. Are there resources available now that might be useful for people who need, want more information?  

Dr. Kamath:  

Yes, are you talking about things that they could find online or read about? It’s in terms in of accessing care or just generally about … 

Katherine:  

Yeah, accessing care.  

Dr. Kamath:  

Yeah. I think there, again, I would go back to the American Cancer Society. The other ones that are really great, too, are – for colorectal cancer, especially, there are a number of really great patient advocacy organizations. The two that are coming to mind are the Colorectal Cancer Alliance and then Fight CRC. Both of them have phenomenal resources as far as patients who have gone through the whole journey and various phases of the journey. What I love for them, too, is usually there’s somebody that can represent your area in those settings, in those support groups and whatnot.  

I definitely think they’re a great resource in helping people find out who are the best doctors in your area. How did you get connected with them? Unfortunately, we all have phone numbers online and whatnot to find us. But we all know when you call them you end up in this interminable loop, it seems like, sometimes to get an appointment. It’s hard to navigate it all. I think a lot of times these patient advocacy organizations can be great bridges to both finding who the right people are and how do you best get in with them.  

What Are Common Colon Cancer Health Disparities?

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What Are Common Colon Cancer Health Disparities? from Patient Empowerment Network on Vimeo.

What are common colon cancer health disparities? Dr. Suneel Kamath explains what a health disparity is, the groups impacted by these differences, and how the medical community addresses them in colon cancer care.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Cancer Institute. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

What Is the Role of Genetic Testing in Colon Cancer Care?

What Is the Role of Genetic Testing in Colon Cancer Care?

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

Transcript: 

Katherine:  

Disparities in healthcare can impact a patient’s experiences and outcomes. What are some common health disparities?

Dr. Kamath:  

Yeah, there are so many. I think with colorectal cancer in particular, access is really a huge one. People who are in underserved communities, often people of color, have less access due to systemic racism in healthcare and in insurance, lack of opportunity with employment. I’ve always thought having a purely employer-based healthcare system is not the smartest idea.  

People who are often the sickest are the least able to work and the least able to maintain their health insurance. It does a disservice to our population to have thing set up that way. Yeah, I think that’s a huge barrier. I think there’s also a lot of stigma, especially amongst people of color, around colonoscopies, things to do with your colon and rectum and whatnot. I think that’s something we also need to work on, to normalize that as something that should be done regularly and that this isn’t a bad thing. It’s just something we all have to do. 

Katherine:  

Right. Well, what is being done by the medical community to address these imbalances? 

Dr. Kamath: 

I’ve really seen, I think, a legitimate push towards community outreach in the last few years. Unfortunately, we’ve known about these disparities for decades and I think a lot has been said about addressing them since the ‘80s and ‘90s.  

But to be honest with you, I don’t think very much was really done until recently. What I’ve seen is a really concerned effort to put resources into identifying what are those barriers. Where is the distrust coming from? Who are trusted sources in your community? We’re tapping into pastors and preachers and the barbershop guy. You don’t ask people, “Who do you trust to get your information from?” If you don’t ask the question you’re never going to know. 

Recently, I think we’ve actually really done the work to find out what is going to motivate you to get something done? What’s going to make it feel normal to you and having trust healthcare? We’re seeing a lot more engagement, I think, as a result of that.  

Katherine:  

Are members of the medical community going out into the African American community to find out who they should be talking to?  

Dr. Kamath:  

We have been, actually. I reviewed a grant – just to speak of Cleveland Clinic in particular, a couple of years ago that the project that is being funded by it is still ongoing. Basically, we conducted focus groups of people at church. After the service was done, we conducted a focus group to ask them, “What are your thoughts about screening?” It was for colon cancer and for others as well. “What are your thoughts about this? What are your fears about it? What are things we could do to make you feel more comfortable with accessing this part of your care? Who do you go to to get trusted information?”  

As a result of that, doing it in their community, in the church setting where they feel safe and comfortable, we saw significant spike in the number of people who came for colonoscopies, for mammograms. We do PSA testing there and we set up a lab there. We found a big spike in the number of people who got those things done and we identified quite a few people who had cancer at early stages and we were able to cure them at much earlier stages than otherwise.  

What Is the Role of Genetic Testing in Colon Cancer Care?

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What Is the Role of Genetic Testing in Colon Cancer Care? from Patient Empowerment Network on Vimeo.

Dr. Suneel Kamath discusses the role of genetic testing in managing colon cancer. From understanding hereditary mutations to the significance of family history, learn why awareness is important.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Cancer Institute. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Research Advances in Colon Cancer Screening and Detection

Research Advances in Colon Cancer Screening and Detection

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

 What Are Common Colon Cancer Health Disparities?

What Are Common Colon Cancer Health Disparities?

Transcript: 

Katherine:

Where does hereditary testing or genetic counseling come in as a screening tool? 

Dr. Kamath:

Hereditary testing, I think, is so important. I wouldn’t say it’s the best screening tool. It’s often best once somebody has already been diagnosed and you know that the disease is in the family. I do think it’s really, really important for people who have a family history of any cancer. Again, I go back to the fact that I think a lot of us don’t really know our family histories. I find for a lot of people when they’re first diagnosed with a cancer, that’s the first time they go talk to Mom and Dad, and to Uncle Joe Aunt Shirley, and they say, “Hey, do we have anything like this in the family?” 

And it actually turns out – I often hear the second and third visits, “It actually turns out I do have a strong family history of cancer.” I just urge people that it’s not an easy thing to talk about, but have that conversation with your family. Also, be open to sharing that information if it was you because these things have heavy implications on everyone in your entire family.  

Also, importantly, it doesn’t have to be the same cancer. A lot of people think it’s only if you have a family history of colorectal cancer that you might be at increased risk of others. But there are many syndromes that link uterine with colorectal and stomach and breast and whatnot. Being aware of any family history of cancer can really help us trigger the right genetic testing to find out if you have a hereditary syndrome or not.  

What Are Colon Cancer Screening Guidelines?

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What Are Colon Cancer Screening Guidelines? from Patient Empowerment Network on Vimeo.

What are the guidelines for colon cancer screening? Dr. Suneel Kamath explains the current recommendations, including the appropriate screening age and reviews risk assessment based on factors such as family history and race. 

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Cancer Institute. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Research Advances in Colon Cancer Screening and Detection

Research Advances in Colon Cancer Screening and Detection

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

 What Is the Role of Genetic Testing in Colon Cancer Care?

What Is the Role of Genetic Testing in Colon Cancer Care?

Transcript: 

Katherine:  

It seems like the suggested ages for screening may vary based on gender and race and family history. What are the current screening guidelines?

Dr. Kamath:

The current screening guidelines that are unfortunately due this rise, there is now recommendation for starting colon cancer screening at age 45. That’s really for everybody. There are certain people that really should be screened even earlier. We definitely know that the black community is affected at a higher rate. There are some professional societies, like the AGA or ACG, that actually recommend starting even earlier in the black community, maybe even by age 40. 

And then, the other thing I always try to emphasize is with this is the usual screening guidelines that we talk about are for what we call the average risk population. I do think that we overestimate how many people are average risk. One of the things that I think is not talked about as much is that if you have a family history of even polyps – high risk polyps – that also means that your family members should get screened earlier, 10 years earlier, than the age that you were found to have a high-risk polyp.  

But my experience has been most people don’t share with their families that they had those. Let’s say I had a colonoscopy done one day and they found those, they get taken out, and they just say, “Oh, come back in three years,” instead of 10. As far as I’m concerned, that’s where it ends. But actually, the fact that I had those polyps has implications for my siblings, for children, and everything. I don’t think most people are in the habit of disseminating that information. As a result of that, a lot of people are probably at increased risk and they’re really not aware of it.

Katherine:

Yeah. Where can patients find the most up-to-date information regarding screening?

Dr. Kamath:

The best resource, to me, is the American Cancer Society, their websites. They’re highly reliable, they’re easy to understand, and I find that they’re very balanced. They’re not going to be overly pushing one side or the other. But they’re going to be evidence-based. As we all know, there is so much fake news and misinformation out there, especially when it comes to health. I think having a resource you could really trust and understand is key and the American Cancer Society, you find, is an excellent resource.  

Why Are Colon Cancer Cases in Young People on the Rise?

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Why Are Colon Cancer Cases in Young People on the Rise? from Patient Empowerment Network on Vimeo.

Why are colon cancer cases rising among young people? Dr. Suneel Kamath delves into the risk factors, early symptoms of colon cancer, and the importance of consulting with your doctor.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Cancer Institute. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Research Advances in Colon Cancer Screening and Detection

Research Advances in Colon Cancer Screening and Detection

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

 What Is the Role of Genetic Testing in Colon Cancer Care?

What Is the Role of Genetic Testing in Colon Cancer Care?

Transcript: 

Katherine:

Well, colon cancer cases in young people are on the rise. Do we know why this is happening?  

Dr. Kamath:  

Yeah, honestly, we really don’t to this point. We have a lot of hypotheses that we’re investigating to get to the bottom of that but it does seem like some of the usual risk factors for developing colon cancer later in life are still true. Obesity, sedentary lifestyle, a diet that’s high in red meat, processed foods. I do think to some extent the fact that we’re doing these things earlier and earlier in our lives. I think we’re seeing that the rates of obesity and overweight are not just increasing but they’re also occurring in people’s teenage years and in their 20s and 30s.  

It’s a time dependent process. I do think some people being at a higher than healthy body weight and leading a sedentary lifestyle starting at age 10 may lead to a cancer by age 30 or 40. I do think that’s part of it. But I do think there’s probably some other undescribed factor. We know plenty of people who come in who are runners and healthy, and honestly they’re healthier than I am to be honest with you and they still develop this for no reason. I am sure there’s some other exposure that we still need to identify.  

Katherine:  

What symptoms should young people be paying attention to?  

Dr. Kamath:  

It’s a great question. Fortunately, with early onset colorectal cancer, it’s much more likely to be on the left side of the colon, or closer to the exit, if you will. 

The good thing about that is the symptoms of it can be a little bit easier to detect. A lot of people describe to me that they have more blood in their stool. They found that they were straining harder than normal or having had a thinner stool caliber. I would also emphasize that these are often symptoms that go on for weeks and months at a time. All of us might eat the wrong thing for a day or two and get some stomach issues here or there so I don’t want people to overreact to every little symptom.  

Certainly, if you’re having constipation that’s going on for several weeks in a row, that’s often not going to be a benign thing. If you have that type of symptom and it’s persistent, definitely talk to your doctor and get it checked out.  

Research Advances in Colon Cancer Screening and Detection

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Research Advances in Colon Cancer Screening and Detection from Patient Empowerment Network on Vimeo.

What are the latest research advances in colon cancer screening and detection? Dr. Suneel Kamath explores cutting-edge screening modalities, including a noninvasive test and innovative blood tests.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Cancer Institute. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Why Are Colon Cancer Cases in Young People on the Rise?

Why Are Colon Cancer Cases in Young People on the Rise?

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

Transcript: 

Katherine:   

The American Society of Clinical Oncology annual meeting just wrapped up. What were the highlights from the meeting related to colon cancer screening and detection?  

Dr. Kamath:  

This was some evidence that came out prior to the meeting but there was quite a bit of buzz about it at ASCO itself. There’s a number of new screening modalities that have obtained their FDA approvals or have had major data releases for, which have looked extremely promising. The first one that comes to mind is the ColoSense test. This is an RNA-based stool test. It’s a stool test similar to Cologuard but it’s a slightly different technology where it’s using RNA instead of DNA like Cologuard did.  

Similar to many of the other tools, it’s showing excellent performance in terms of how sensitive it is to detecting colon cancer. They showed in a prior publication they could detect almost 95 percent of colorectal cancers. It was also a rather specific test, too, so 88 percent specificity. What this is telling us is that this test if very good at detecting colorectal cancer when it’s there but also, equally importantly, it’s very good at not giving you a false positive, which is also very important with any screening test.  

So, we’re really excited to see that. We’re increasingly thinking about noninvasive ways, beyond colonoscopy, that we can improve colon cancer screening.  

Katherine:  

How does it compare with Cologuard, then?  

Dr. Kamath:  

This one is called ColoSense, yeah. I would say both of these numbers in terms of the sensitivity, meaning that’s the level of detection. If someone does have colorectal cancer, how well do you detect that. That sensitivity of almost 95  percent is definitely a little bit higher. Specificity is also, I would say, a little bit higher. I do think that this test would likely both detect more colorectal cancers that Cologuard would and it would also give you fewer false positives at the same time.  

Katherine:  

And is this going to be something that people can take the test at home?  

Dr. Kamath:  

Yes. This should be because it says a stool-based test. I’m sure a lot of the logistics would still need to be worked out, as with any new test. Having the kit sent to the primary care doctors’ offices and things like that. Arranging for that infrastructure, I’m sure, will take some time. But, yes, this test is pretty easy and simple to do. It should be the same as sending in any other stool-based test into a lab.  

Katherine:  

Is there other research you’re excited about?  

Dr. Kamath:  

Yes. Another one that I’m really excited about is there are these blood-based screening tests as well. A couple are coming to mind. One is from Guardant Health. They have been developing this assay specific for colorectal screening for some time. They’ve also been talking about their data for a blood-based test.  

For them, the number is also still quite good. They’re saying that the sensitivity is about 83%, so maybe a little bit lower than the RNA one but specificity is 90 percent. So, maybe actually a little bit better with that. So, I’m very excited about this one because this is a blood-based test that could be done at a doctor’s office. We all know practicalities are if you can just order a test in the lab and have someone get a draw the same as getting your lipid panel checked or other things that are routinely done, that’s very easy to do and you can be pretty certain someone’s going to follow  through on that.

Whereas, we know with these stool-based tests, it’s about a third to half of patients, even though you send them home with a kit, you may not get the specimen back at all.  

Millennial Stage IV Colon Cancer Survivor Urges Earlier Screening

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Millennial Stage IV Colon Cancer Survivor Urges Earlier Screening from Patient Empowerment Network on Vimeo.

 Stage IV colon cancer patient Ashley received her diagnosis at age 33. Watch as she shares her story starting with a routine physical, surgery and treatments that she endured, and lessons learned during her cancer journey.

Special thanks to our partner, Colorectal Cancer Alliance, for helping to make this vignette possible.

Transcript:

My name is Ashley, and I’m from West Virginia but currently reside in Nebraska. In February 2021, I was diagnosed with stage IV colon cancer at the age of 33.

I decided I wanted to join the Air National Guard and had to complete a physical examination. After visiting a hematologist/oncologist for dangerously low iron and hemoglobin levels, I went in for a routine physical a few months later. The physician’s assistant found a mass in my stomach area, and they sent me for a CT scan. The next morning, my husband Josh got the call that I missed. The CT scan had shown three different masses – and was likely cancer.

I was dumbfounded, shocked, and then I felt the tears rolling down my face. My doctor informed me, “You need surgery immediately, since the tumors are getting close to completely closing up your colon.” I also had a tumor on my liver.

I had surgery to remove the tumor before it closed my colon, but the surgeon couldn’t get to the tumor on my liver. After surgery, they told me the three most important things to do while there that would get me home sooner were eating with no issues, walking, and having a bowel movement.

Finally after two surgeries where my liver, gallbladder, one-quarter of my colon, part of my small intestines, appendix, two large tumors, and a lymph node that turned into a tumor was removed, as well as 12 rounds of chemo.

I received news in March 2022 that my cancer is back but will not be as aggressive as it was before. I am taking things one step at a time and one day at a time, trying to stay optimistic at each step.

When someone gets cancer – the “journey” is never over. The fear NEVER goes away. Even when you are declared to have no evidence of disease, there is a possibility cancer can come back. And if it does come back, the chance of fighting and winning again gets slimmer.

If you know someone that has cancer – be kind – just because they don’t look sick, doesn’t mean they aren’t having challenges. Just because their numbers and scans are good doesn’t mean they are in the clear for the rest of their life. Always, always – BE KIND!

Some of the things I have learned during my colon cancer journey are:

  • Get your colon cancer screenings on time. Or if you’re too young like me, listen closely to what your body tells you and get annual physicals.
  • Say yes to those who want to help by bringing food, checking in, or donating. We are amazed by the support we’ve received from friends, family, and complete strangers.
  • Fighting the cancer fight is much easier knowing how many people are on our side and how much love there is for us out there.
  • Advocate for yourself! Do research on your specific type of cancer and mutations. If you feel you are being told something that just doesn’t seem right, question it – push the bar until you can’t anymore! There are so many options out there when it comes to cancer and survival, you just need to find the right person that will take care of you!

These actions are key to staying on your path to empowerment.

Advice From a Young-Onset Colorectal Cancer Patient

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Advice From a Young-Onset Colorectal Cancer Patient from Patient Empowerment Network on Vimeo.

Colorectal cancer patient Jessica was surprised but not shocked even after a diagnosis under the age of 40. Watch as she shares her journey from symptoms, diagnosis, her advice to others, and coping methods she’s found helpful for navigating her experience as a patient.

Special thanks to our partner, Colorectal Cancer Alliance, for helping to make this vignette possible.

Transcript

My name is Jessica, and I’m from Chicago, Illinois. Even though my doctors thought I was too young, I was diagnosed with colorectal cancer at age 39.

I’d been experiencing occasional rectal bleeding for about a year when I was finally referred for a colonoscopy.

While my doctors were convinced that I was too young for colorectal cancer, I was still worried because my grandmother died of the disease.

My doctor asked me to go in to get my colonoscopy results. My parents knew what that meant, so we went together. When the GI gave me the results, stage III rectal cancer, I felt so scared. I called my best friend, and I couldn’t even speak. We just cried together.

After I received my diagnosis, my doctor told me it’s very curable. I had a 2-inch mass in my rear. I had a CT scan to confirm the cancer had not spread followed by an MRI. And that’s when the whirlwind began.

I returned to a craft I hadn’t used much in recent years. To sort my thoughts, to update my friends and family, to document the most important year of my life, I started writing again. Beginning a blog was at once a coping mechanism for me and the best way I knew how to share this breathtaking news with friends and family I’d collected from across the country and over decades — and still conserve energy I would need to fight this fight.

Five years later, and I’m thriving.

I want to raise awareness about the rising incidence of colorectal cancer in the under-40 crowd because I was symptomatic and ignored before I was diagnosed. I know that not everyone is as lucky as me, especially young people who are often diagnosed at an even more advanced stage.

Some of the things I have learned during my colorectal cancer journey are:

  • Watch out for signs your body gives you
  • Don’t take “no” for an answer even if doctors think you’re too young for colorectal cancer.
  • Cases of young-onset colorectal cancer are increasing, and that’s why funding colorectal cancer research is so important.
  • Find something to do to help you cope. If you’re unsure whether it’s a healthy activity, ask your doctor or care team member who you trust.

These actions are key to staying on your path to empowerment.

Is the COVID-19 Vaccine Safe and Effective for People With Colon Cancer?

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Is the COVID-19 Vaccine Safe and Effective for People With Colon Cancer? from Patient Empowerment Network on Vimeo.

Dr. Smitha Krishnamurthi, a colon cancer specialist at Cleveland Clinic, provides vaccine safety information and discusses the effective immune response after COVID-19 vaccination in patients with colon cancer.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

Should Your Family Members Be Screened for Colon Cancer?

Transcript:

Katherine Banwell:

Is the COVID vaccine safe and effective for people with colon cancer?

Dr. Krishnamurthi:

Yes. The COVID vaccine is safe. We have no data that patients with colorectal cancer or patients who are undergoing chemotherapy are at any increased risk of any side effects from the vaccine. People should be able to make a good immune response. Patients who are not able to make a good immune response are those who are getting very high-dose chemotherapy, like a bone marrow transplant or an organ transplant. But chemotherapy for colorectal cancer should not be problem. We basically advise – I ask all my patients to get the vaccine. They should just get it whenever they can. They don’t have to worry about timing in regards to their chemotherapy.

Katherine Banwell:

Okay. Dr. Krishnamurthi, thank you so much for joining us today.

Dr. Krishnamurthi:

Katherine, thank you so much for having me. It’s been such a pleasure.

Colon Cancer Treatment and Research News

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Colon Cancer Treatment and Research News from Patient Empowerment Network on Vimeo.

What’s the latest colon cancer treatment and research news from the American Society of Clinical Oncology (ASCO) meeting? Dr. Smitha Krishnamurthi shares updates about research findings that were presented at the meeting along with exciting ongoing research in colon cancer.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

Should Your Family Members Be Screened for Colon Cancer?

Transcript:

Katherine Banwell:

Welcome, Dr. Krishnamurthi. Would you mind Would you mind introducing yourself?  

Dr. Krishnamurthi:

Sure, it’s my pleasure. Thank you for having me, Katherine. I’m Smitha Krishnamurthi. I’m a medical oncologist. I specialize in taking care of patients who have colorectal cancer and other gastrointestinal cancers. As a medical oncologist, I treat patients with drug therapy like chemotherapy and immunotherapy.  

Katherine Banwell:

And where are you located?  

Dr. Krishnamurthi: I work at Cleveland Clinic in Cleveland, Ohio. 

Katherine Banwell:

Excellent. Thank you so much.  

Cancer researchers came together recently to share findings at the annual American Society of Clinical Oncology meeting, also known as ASCO. Are there highlights from the meeting that patients should know about?  

Dr. Krishnamurthi:

Yes. That’s always such an amazing gathering of knowledge. Thankfully, it’s continued virtually at least due to the pandemic. This past ASCO last month, some of the major highlights in colorectal cancer were the final overall survival results were presented from the study of pembrolizumab versus chemotherapy as first-line treatment for patients with metastatic colorectal cancer with deficient mismatch repair or MSI high status.  

These are the patients who are predicted to benefit from immunotherapy.  

We’d already seen earlier results that the patients who received the immunotherapy up front had a much-improved time for the cancer to regress. Here, they presented the overall survival results, which showed that the median survival for patients who received chemotherapy was three years, meaning half the patients lived shorter time, half lived longer. For the patients who received the pembrolizumab, they hadn’t even reached the median survival at five years.  

So, it looks very important that we know this MSI status or mismatch repair status from the beginning, so that we can offer the right patients immunotherapy first.  

Other highlights were, for example, for patients who have cancers that overexpress HER2/neu. It’s an oncogene. When it’s overexpressed, it tends to drive growth of cancers.  

 We don’t have any FDA-approved drugs for HER2-amplified colorectal cancer, but there are many studies showing that those patients with that type of cancer benefit from targeting this HER2 protein. There are, of course, approved drugs for HER2/neu-amplified breast cancer and stomach cancer. One of these drugs is trastuzumab deruxtecan.   

It’s a drug that targets the HER2/neu protein, but it’s connected with chemo. So, it’s like bringing chemo right to the tumor. The results showed a very high response rate. But it does have a peculiar toxicity of causing inflammation in the lung. So, it’s another treatment option that could be approved. It’s good to see that we’re getting more treatment options there. 

Katherine Banwell:

What are you excited about when it comes to colon cancer research? 

Dr. Krishnamurthi:

There are so many important questions we still need to learn the answers to. I find that patients who have, of course, a mutation of the KRAS or NRAS gene and have metastatic cancer, they have fewer treatment options than when those genes are normal. 

KRAS is a very important oncogene driver of cancer in colorectal cancer, but also in lung cancer and pancreatic cancer. For many decades, it was thought that there was no way to target this protein. Now, we’re seeing that there’s a certain type of KRAS mutation – KRAS G12C – that can be targeted with drugs that now are approved in lung cancer. 

It’s a small fraction of colorectal cancer patients who have that mutation, but it’s like we’re beginning to crack this code. The most common KRAS mutation is G12D. There is a company – Mirati – that has a candidate G12D inhibitor that’s going to enter clinical trials this year. It’s very exciting.   

There was recently a press release onvansertib, which is a polo-like kinase inhibitor, combined with chemotherapy, a second-line treatment for patients with KRAS-mutant colon cancer, showing a much higher response rate than we would expect with the chemotherapy alone.  

That will need to be validated in a large, randomized trial, but that’s looking very exciting. Then the other aspects that I’m most excited about are how to get immunotherapy to work for more of our patients.   

We know that patients who have abnormal mismatch repair or MSI-high cancers can benefit remarkably in the metastatic setting and there are studies going on in the early-stage setting and there are reports of it looking quite promising. But how do we get it to work for the majority of patients who have normal DNA mismatch repair or MSS, microsatellite stable cancers? That’s an area of great interest.  

We’ve seen a study in the Netherlands where they treated patients with normal DNA mismatch repair, early-stage colon cancer, with just two doses of immunotherapy before going to surgery for their early-stage cancer. I was surprised to see like four out of 15 patients responded to the treatment. Perhaps earlier stage cancers may be more responsive to immunotherapy. Definitely looking forward to more updates from that study, which we’ll probably hear in the fall at the European Society of Medical Oncology meeting in fall of 2021. 

Then, of course, the other area that really interests me is what is causing this epidemic of colorectal cancer in young adults? This is really a matter of laboratory studies and epidemiologic studies, but that’s also an area of great interest.  

Katherin Banwell:

There’s an epidemic among younger people?  

Dr. Krishnamurthi:

Yeah. I think of it as an epidemic in that colorectal cancer has definitely been increasing in young Americans and young people around the world in many countries.  

Basically, clearly, there’s been an increase since the 1980s. It seems to be something environmental because it’s related to time. So, it’s not inherited. Some of our patients below the age of 50 diagnosed with colorectal cancer do not have an inherited cause. A study from Ohio State found that 16 percent have an inherited cause. So, 84 percent of them do not. This is definitely increasing, particularly of rectal cancer. I think it must be something environmental. Possibly something like we’re ingesting because our colon is exposed to what we eat. But we really don’t know yet.  

And so, I just advise all my patients and everyone who is interested to just try to eat as much natural food as we can. To try to minimize processed foods and chemicals. 

Because I think that’s the best we can do until we really identify the cause.  

Should Your Family Members Be Screened for Colon Cancer?

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Should Your Family Members Be Screened for Colon Cancer? from Patient Empowerment Network on Vimeo.

When should members of your family get colon cancer screening? Dr. Smitha Krishnamurthi from Cleveland Clinic shares screening guidelines for family members and discusses the necessity of genetic counseling.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

How Is Colon Cancer Treated?

Transcript:

Katherine Banwell:

If you’ve been diagnosed with colon cancer, what is the guidance for screening family members, such as children and siblings?

Dr. Krishnamurthi:

Yes, this is an excellent question. We tell all our patients who have been diagnosed with colorectal cancer that their first-degree relatives should start screening by age 40, but also 10 years younger than the youngest affected member of the family. So, whichever is younger.

If my patient is 45, definitely that person needs to have genetic counseling because they’re young for colorectal cancer. Then we’d recommend at least start by age 35 for their children or siblings, even if no inherited cause is found.

Katherine Banwell:

Okay, all right.

How Speaking Up Can Positively Impact Your Colon Cancer Care

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How Speaking Up Can Positively Impact Your Colon Cancer Care from Patient Empowerment Network on Vimeo.

Why should you advocate for the best care for you? Dr. Smitha Krishnamurthi, a colon cancer specialist from Cleveland Clinic, provides key advice to access better care, including the value of second opinions, and why you should feel empowered to speak up.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

Should Your Family Members Be Screened for Colon Cancer?

Transcript:

Katherine Banwell:

What is your advice to patients who may feel like they’re hurting feelings by seeking a specialist or even a second opinion?

Dr. Krishnamurthi:

I would advise patients to not worry about that at all. I think that any one of us diagnosed with colorectal cancer would want a second opinion, would want to make sure that we’re getting an opinion from a high-volume cancer. Working here are Cleveland Clinic, I have the luxury of focusing on treatment of gastrointestinal cancers, whereas my colleagues who are in the community are treating patients with all different types of cancers. They have to be knowledgeable in all different types of cancers.

I think that’s actually much harder. I think that if your oncologist is not a specialist, the oncologist may actually appreciate having an opinion from a specialist, which helps them as well.

I think that if the doctor is going to be offended, then that’s probably not the right doctor to see. I think it’s important to just advocate for oneself and go for it.

Katherine Banwell:

That leads to my next question. What advice do you have about self-advocacy, about speaking up for yourself as a patient?

Dr. Krishnamurthi:

I think that’s very important to feel comfortable with your treatment team, with the doctor, nurse, nurse practitioner. If you have the luxury where you have choices where you live, seek out somebody who you can really connect with. I think it’s very important for the treating team to know what the patient is going through.

We have to know how the treatment is going so that we’re dosing properly, making adjustments. We want to know what our patient’s goals are so that we’re providing the best quality care.

I think it’s helpful to bring somebody to appointments. Or if you can’t bring somebody, you’ll call them on the phone. We’re doing that a lot now. People are joining by video call or even speaker phone. Many offices will have a speakerphone. You can ask to have somebody called on your behalf. Especially with COVID and the restricted visitation. Let’s get people on the phone. Somebody else to listen for you. For the patient, I mean, and to take notes. That really helps

Newly Diagnosed With Colon Cancer? Key Advice From an Expert

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Newly Diagnosed With Colon Cancer? Key Advice From an Expert from Patient Empowerment Network on Vimeo.

Dr. Smitha Krishnamurthi, a colon cancer specialist from Cleveland Clinic, shares steps to take following diagnosis to ensure patients are receiving optimal care.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

Your Colon Cancer Care Colon Cancer Toolkit: Office Visit Planner

Transcript:

Katherine Banwell:

What three key pieces of advice would you have for a patient who has just been diagnosed with colon cancer?

Dr. Krishnamurthi:

Okay. Yes, when somebody received a diagnosis of colon cancer, of course it’s a very serious diagnosis. I would always encourage patients to seek out expert care. Meaning see a person who specializes in treatment of colorectal cancer. So, a colorectal surgeon and a colorectal medical oncologist. I am a medical oncologist who specializes in treatment of patients with gastrointestinal cancer.

These sorts of specialists are typically found at high-volume cancer centers. Look for National Cancer Institute-designated comprehensive cancer centers. That designation implies very high quality of care and that there’s a lot of basic science research, clinical research, and what we call translational research. Like trying to bring lab discoveries to the bedside. I would encourage that for everybody. Of course, not everyone lives near such a center, but what we’ve learned through the pandemic is that we can use telemedicine far more than we ever did before.

We do a lot of virtual visits with patients who may live many hours away. I think it’s important, even if you have one visit for a second opinion, a treatment plan, that you could then receive that treatment with the local oncologist. I think that’s very helpful, and I would encourage everyone to seek out an expert opinion.

Also, I think it’s very important to seek out as much support, because this is a major diagnosis and a lot to go through. There is a lot of support out there that people may not be aware of besides, of course, family and friends. There are excellent patient advocacy groups and groups like your organization, trying to bring information to patients. Patients can ask their doctor or nurse about what’s local in terms of support groups, but there are also large internet presences by patient advocacy organizations. They are giving people high-quality, evidenced-based recommendations, advice.

People get to learn from other peers who have gone through treatment. I can’t name them all, but just for example, like the Colon Town and Colorectal Cancer Alliance. I believe just launching today is My Bluem, B-L-U-E-M.org.

I happen to be executive board member of that, so full disclosure. But it’s an organization created by colorectal cancer survivors for patients to come to one website to access information about all of these different organizations. There is a huge community out there for people who are diagnosed with colorectal cancer. The third piece of advice, I would just say when you’re looking for information, make sure it’s from a reliable source like these patient advocacy organizations. I tend to look myself for websites that end in .org, .gov, .edu, and also .net.

Our American Society of Clinical Oncologists organization is ASCO.net, where you can get great advice about cancers. Cancer.gov, cancer.org. Because the internet is full of suggestions which may not be based in good science.

It’s important to have a good source.

Katherine Banwell:

Good advice. Thank you for that.

What Should Be Considered When Choosing a Colon Cancer Treatment Approach?

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What Should Be Considered When Choosing a Colon Cancer Treatment Approach? from Patient Empowerment Network on Vimeo.

Dr. Smitha Krishnamurthi, a colon cancer specialist from Cleveland Clinic, reviews considerations when choosing therapy, including staging and test results, as well as how clinical trials fit into treatment planning.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

 

Newly Diagnosed With Colon Cancer? Key Advice From an Expert

Your Colon Cancer Care Colon Cancer Toolkit: Office Visit Planner

How Speaking Up Can Positively Impact Your Colon Cancer Care

Transcript:

Katherine Banwell:

What are the main factors you take into consideration before a treatment approach is decided on?

Dr. Krishnamurthi:

For treatment of anyone with colorectal cancer, most important, of course, is the stage because stage determines whether it’s surgery alone or do we need to use chemotherapy or radiation? Or if it’s metastatic, is it systemic treatment only? We also look at the biologic features of the cancer, which we’re learning more and more are very important.

For example, we want every patient to know their DNA mismatch repair status. This is basically, is the cancer missing a gene that repairs damage to DNA? Then if that’s true, then we say they are DNA mismatch repair deficient. Or another term is “high microsatellite instability.” Mismatch repair deficient or microsatellite instability high, or you might hear MSI high.

That’s very important that we test that on all patients with colorectal cancer because in the early stage setting, it’s important because this is a way to identify patients who may have Lynch syndrome, the most common type of inherited colorectal cancer.

And also it impairs their prognosis. We know these patients tend to have a better prognosis. For example, for stage 2, we wouldn’t even have a conversation about chemotherapy if we know the patient has abnormal DNA mismatch repair or is MSI high. Then for patients of metastatic disease, it’s very important to know this upfront because those patients do better with immunotherapy as their first treatment.

So, we want to see those results for each patient. Then for our patients with metastatic cancer, we also need to see some other genetic mutations such as RAS, KRAS and NRAS gene mutations, because that affects what treatments we use.

Also, BRAF gene mutations are very important because of the particular regiment we use for treatment of that type of cancer.

We’re looking at the extent of the disease, what are the molecular features, and then also, of very importantly, what can the patient tolerate? What are the patient’s goals? We have a discussion about side effects and help them make the best choice for themselves.

Katherine Banwell:

Where do clinical trials fit in?

Dr. Krishnamurthi:

That’s an excellent question because clinical trials actually could be appropriate at any step along this pathway.

There are clinical trials that may be looking at tests to diagnose cancer better or detect it earlier.

There are treatment trials where they may be looking at standard treatment versus something investigational or standard plus investigational. Those sorts of treatment trials may be very interesting as the initial treatment or they could be used when a person has gone through all the standard treatments. Then there’s nothing left to do but try investigational. There are also studies that are looking at supportive care – a new treatment for nausea, for example. There are studies that are looking at the biologic factors of the cancer. Maybe asking a person to donate blood or give permission to use their tumor sample. By participation in these studies, people who volunteer for that are being so generous with their time and their lives.

But that’s how the field advances, especially for treatment trials. This is a way to access cutting edge treatments because the study is being done because the drug looks promising.

I think it’s very important to ask about clinical trials from the beginning and every time there’s a decision point made in the treatment.

How Is Colon Cancer Treated?

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How Is Colon Cancer Treated? from Patient Empowerment Network on Vimeo.

Dr. Smitha Krishnamurthi, a colon cancer specialist from Cleveland Clinic, shares an overview of colon cancer treatment and which approaches are used for each stage for optimal patient outcomes.

Dr. Smitha Krishnamurthi is a gastrointestinal medical oncologist at the Cleveland Clinic. Learn more about Dr. Krishnamurthi here.

See More From The Pro-Active Colon Cancer Patient Toolkit

Related Resources:

Transcript:

Katherine Banwell:

Can you provide us with an overview of how colon cancer is treated?

Dr. Krishnamurthi:

Yes. Colon cancer is treated based on the stage. It’s a disease that, for the vast majority of patients, is only cured with surgery.

If it can be surgically resected, that’s how this disease is cured. So, it’s very important that we do all we can to maximize early detection because it’s a highly curable cancer when it’s caught early. For early-stage colon cancer, patients are treated with surgery. So, stages 1, 2, and 3.

If it’s rectal cancer, we do some treatment before surgery. We give some chemotherapy and radiation for stages 2 and 3 beforehand to maximally shrink down the tumor to enable the surgeon to take the tumor out of the pelvis with normal tissue all around, like negative margins. Rectal cancer tends to be more complicated surgery because of its location in the pelvis.

So, it’s a little bit different from colon cancer in that we do that chemo radiation and chemotherapy up front. Whereas, for colon cancer, patients who have early-stage disease have surgery. And then, if it’s just stage 1, and this is true for rectal also, they’re done.

Excellent prognosis and go on to surveillance.

But if it’s a stage 2, then in colon cancer we have a discussion about chemotherapy afterwards because that could increase the cure rate for some patients. But for stage 3, we absolutely want to offer chemotherapy to our patients with colon cancer because of this very long, proven track record that chemotherapy can increase the cure rate for stage 3 patients, so when it’s gone to lymph nodes. Then if the disease is metastatic, meaning it’s spread to other distant organs like liver or lung, chemotherapy is the mainstay of treatment, generally speaking.

But there are subsets of patients who benefit from surgery. So, if the cancer is metastasized to just the liver or the lung or both organs, but in limited fashion, there is a track record for patients being cured with surgery.

We always are considering that when we have patients with metastatic disease. My first thought is, is this cancer potentially curable? Then we go from there. In some cases, it’s clear that it’s not curable; it’s widely metastatic. Then there’s no point in subjecting a person to surgery and we know that chemotherapy or drug therapy would be the mainstay of treatment.